Health system redesigns its imaging management structure around modalities, rather than operating lines
A Georgia hospital system is detailing how it recently redesigned its imaging management structure around modalities, rather than operating lines.
Healthcare organizations have increasingly expanded through mergers and acquisitions, creating legacy operating units that encompass hospitals, related outpatient clinics and imaging centers. This has left radiology services in these scenarios often deployed via vertical management models, which can limit systemwide standardization and coordination, experts write in JACR.
At Atlanta-based Emory Healthcare, this fractured approach had resulted in uneven technologist staffing, variable asset utilization and scheduling, and diverging modality quality and safety practices. Amit M. Saindane, MD, MBA, and colleagues said their new configuration is paying dividends, sharing some of the key takeaways on Feb. 13.
“Transitioning from a vertical, operating unit-centric model to horizontal, enterprise-wide modality teams fosters better alignment across [operating units] and accountability within radiology,” Saindane, chair of Emory’s department of radiology, and co-authors noted.
Emory Healthcare first initiated the reorganization and integration with its single academic physician practice in September 2023. At the time, the system consisted of five separate operating units, each with one to three hospitals and up to five hospital-based outpatient imaging centers. Frontline technologists, modality supervisors and managers reported to an operating unit administrative director of radiology, who answered to a hospital operations leader and ultimately the CEO.
With guidance from human resources, all operation-unit director roles were eliminated, replaced with seven enterprise modality director roles. These new positions were responsible for systemwide oversight of each imaging modality (i.e., MRI, CT). Multimodality managers were then transitioned to single-modality roles, “enabling deeper specialization and consistent operational oversight.” Meanwhile, modality supervisors “remained untouched, providing on-site continuity” for the more than 1,000 technologist team members. Emory also created a new site director role to serve as an operations unit liaison without having authority over modalities. It also created four enterprise director roles to oversee quality, safety, analytics and informatics, finance and business development.
“Following reorganization, workforce initiatives included well-coordinated, systemwide recruitment efforts,” the authors wrote. “Enterprise modality leadership expanded relationships with technologist training programs, creating stronger pipelines for new hires. Technologist ‘float’ pools were implemented to balance staffing across [operating units], a practice not possible in the prior OU-based model.”
Emory also added the role of technologist assistant to take on “non-modality scanning tasks,” allowing critically understaffed techs to work more efficiently. It further implemented a new modality-specific, skills-based compensation structure to help support technologist advancement, ensure competitive pay and promote retention. The organization also worked on “coordinated scheduling template optimization,” increasing visibility of open imaging slots, expanding patient self-scheduling and tailoring workflows to each modality’s operational constraints.
As technologist recruitment improved, Emory was able to expand hours to help increase utilization. The organization believes it is among one of the first to implement this type of direct-line, imaging modality-based management reporting structure. It touted numerous benefits from the changes. Director and manager positions were reduced by 15%, with nearly all prior managers and directors finding new jobs. Technologist headcount increased by nearly 11%, first-year turnover dropped by 34%, and overall turnover fell by 55%.
Employee engagement also leapt, as measured by Press Ganey scores. The number of individuals answering positively to the question “I feel like I belong in this organization” increased from 78% in 2023 up to 82% two years later. Overall health system scores also increased from 76% to 78% during the same timeframe.
“Realized improvement in employee engagement was not surprising due to widespread early acceptance and excitement about the reorganization across radiology leaders and frontline technologists,” the authors noted. “Given the shortages of radiologic technologists, it was critical to leverage modality-specific pipelines, compensation approaches, and opportunities for development and advancement to promote recruitment and retention.”
Meanwhile, overall weekday capacity utilization increased from 59% to 75% and 15% to 47% on weekends after two years. The percentage of outpatients scheduled within 10 days increased from 73% to 78%, “with far greater gains within some modalities.” Improvements in access and capacity utilization translated to a 19% increase in work relative value units at the imaging modality level after two years and 27% increase in provider wRVUs.
Saindane and co-authors noted that generalizability of their efforts may be limited, given their organization’s geographic compactness, which facilitated modality-based oversight. Challenges of the new system included communication gaps and resistance to change, which must be “proactively addressed through clear role definitions, aligned targets and leadership support.”
“The biggest limitation of this observational study relates to lack of a control group and potentially confounding effects on our tracked outcome metrics from other contemporaneous enterprise initiatives,” the authors concluded. “Nonetheless, we believe the relatively rapid and substantial longitudinal improvements we observed warrant consideration of the imaging modality-based model for other organizations, with recognition of tradeoffs and mitigation of resultant challenges.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.